However, even though the United States has one of the highest quality of public drinking water, the future of that system is not a given.  And, the problems in our water system lie both above and below ground level.

Above ground, the effects of a warming planet are apparent.  For example, major droughts have engulfed many areas of the country, especially in parts of the Southwest and the central plains.  Scientists say these droughts will continue, and one season of plentiful rain – like the most recent wet winter in California – doesn’t solve this ongoing problem.

According to the Center for Disease Control and Prevention (CDC), “When drought affects a community, its devastating consequences can include increased risk to human health, decreased water quality, and decreased food production. These effects can be far-reaching, complex, and costly.”

Shannyn Snyder, department of global and community health, George Mason University, wrote on the website, The Water Project, “It seems impossible that a powerful river, like the Colorado River, is beginning to run dry in places. It seems farfetched that a huge body of water like Lake Mead in Arizona might become obsolete, but these and other dramatic changes are facing the United States.”

“Water scarcity is a global concern, and that means there’s even a problem in our own backyard,” Snyder added.

Below ground is a different set of problems, but equally challenging.

Most notable is an aging water infrastructure that has been badly neglected.  Cast iron water pipes – some dating to the 1880s – need to be replaced in communities throughout the nation.  According to EPA, the cost of replacing these old pipes and bringing treatment plants up to date could cost upwards of $384 billion.

Water main failures and burst pipes are also an issue.  The American Society of Civil Engineers estimates about 240,000 water pipe failures of varying degree occur annually.  Usually, these broken pipes are patched instead of completely replaced.

“It’s a huge problem nationwide,” said Erik Olson, director of the health and environment program at the Natural Resources Defense Council.  “A lot of [the water infrastructure is] now 100 years old or more. We haven’t been taking care of it.”

In fact, antiquated water pipes were at the heart of the disaster in Flint, Michigan.

In 2014, to save money, the city changed water suppliers.  Not long after, residents began complaining about the water quality, but city officials denied there was a problem.  Yet, there was a problem, and it was serious.  The new source of water, the Flint River, was stirring up corrosion in the fragile pipes thereby causing them to leach lead and other contaminants into the public water system.

The Environmental Protection Agency (EPA) has determined lead is harmful to health, even at low levels.  Additionally, lead is persistent and can bioaccumulate in the human body over time.  Lead is of special concern for children.  In worst case scenarios, lead can cause both behavioral and neurological problems in kids.

To learn more about the Flint calamity, its timeline and the outcome, listen to NPR’s radio broadcast “Lead-Laced Water in Flint: A Step-By-Step Look at the Makings of a Crisis.”

What happened in Flint was a severe case, but it isn’t the only community battling lead in their water.  Many schools, for example, have found high levels of lead in tap water in its schools.

John Abeigon, president of the Newark Teachers Union, told television reporters that Newark public schools are a “mini-Flint,” with tests revealing that at least 30 schools in the city show lead contaminated water samples.

While lead has grabbed most of the headlines, there are dozens of other substances that can pollute water, such as the highly toxic chemical perchlorate and atrazine, which is the most detected pesticide found in U.S. waters.

The EPA provides a comprehensive list of both man-made and natural sources of water contamination on its website.

The future of water is complicated.  The federal government has demonstrated a tepid interest in a complete overhaul of the nation’s water systems.  Part of this is because managing, delivering and paying for water mostly happen at the local level.  Communities, especially small and rural, often lack the funds to conduct a massive renovation of the system.

Most experts agree the days of cheap water are coming to an end.  To finance these badly-needed improvements, consumers will pay higher prices.  They will also be required to conserve much more water than they have done in the past.

For their part, water providers will be forced to look at new alternatives for reusing water, and that will carry a high price tag as well.

First identified – and named for – Lyme, Connecticut in the 1970s, the disease has spread steadily.  It’s now found in almost half of the counties across the U.S.  The Center for Disease Control and Prevention (CDC) estimates as many as 300,000 individuals may be infected with Lyme each year, the vast majority of cases going unreported and untreated.

Kiersten Kugeler of the CDC told NPR News, “What’s important for people to know is that the ticks are spreading to new areas — and tick-borne diseases are coming with them.”

Facing an increased risk, should patients be advised to stay indoors?

Public health professionals say no.  It’s good to be out in nature, gardening, walking, hiking, biking, camping and more.

“Ticks are a problem along with a lot of other outdoor hazards, but you don’t need to fear going outdoors,” said Richard Dolesh, Vice President of Strategic Initiatives at the National Recreation and Park Association.

Instead, patients should be encouraged to focus on prevention and early intervention.
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These are some tactics and strategies to avoid being bitten, and what to do if you are:
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• The deer and black-legged ticks that carry the Lyme bacteria are tiny, even as small as a poppy seed, and their bite is painless. They are most likely to be found in areas of woods, fields, tall brush or high grasses, but the ticks are also found under leaves or ground cover and other low-growing vegetation.   Keep your yard free of debris and consider fencing the yard if you have wild animals that could pass through.
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• Cover as much skin as possible. If ticks are unable to reach your skin, they can’t bite.  Long-sleeved shirts are a good option and tuck the bottom of pants into socks.  Ticks seem to like hiding behind the ears, on the scalp, in the armpit, on the back, and also the groin.
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• After spending time outside, do a tick check. Wearing light-colored clothing makes this a lot easier.  It’s also a good idea to shower after spending time outdoors.
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• Certain insect repellent will help keep the ticks at bay. The best choice is one that contains 20 to 30 percent DEET on exposed skin and clothing.  Products containing 0.5 percent permethrin can be used on clothing and outside equipment, but never on skin.
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Visit the Environmental Protection website to learn more about repellents.

If you find a tick that has already latched on and is attached to your skin, don’t despair!

The first step is to remove the tick.  Never use heat to remove a tick or attempt to crush it with your finger.  Instead, use a tick-removal device you can find at most local drug stores, or a fine-tipped tweezers, which can work just as well.  Using the tweezer or other device, grasp the tick at its head and close the surface of the skin, then pull upward with a steady, even amount of pressure.  Avoid any twisting motion so you don’t break the tick.
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Here’s how to stay safe from ticks:
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• After the tick is removed, clean the bite area and your hands with alcohol, an iodine scrub, or soap and water. To dispose of the tick, first submerge it in alcohol and then either flush it down the toilet or place it in a sealed bag or container and dispose of it in the garbage.
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• Tell patients to be on the lookout for symptoms and don’t assume they will just go away. See a doctor if symptoms appear within days or weeks of the bite.  However, it is important to know that if you have symptoms but never noticed a bite, you can still have Lyme’s disease.
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Early detection is important for diagnosing and treating Lyme disease.

In the days and weeks following a bite, LymeDisease.org, a advocacy, education and research website, says individuals might see a distinctive red bullseye or a round rash, followed by flu-like symptoms, fever, headache, fatigue, muscle and/or joint pain, and sometimes a weakness in the limbs.  Some patients might also experience partial facial paralysis, shortness of breath, heart palpitations, and severe swelling of the larger joints.

A round of antibiotics can cure Lyme disease and patients usually recover completely.

However, if Lyme goes undetected and untreated, it can lead to serious, chronic health problems.  The CDC outlines these conditions, including significant neurological issues like short-term memory loss, inflammation of the brain and the spinal cord, nerve pain, facial palsy, sensitivity to light.

Lyme is diagnosed through the evaluation of symptoms, a history of exposure to infected ticks, and through a laboratory blood test.  To avoid misdiagnoses, the CDC strongly recommends a two-tier process when testing blood for any evidence of antibodies against the Lyme disease bacteria.